Intracranial subdural hematoma is an entity characterized by the rupture of the bridging veins that are found in the subdural space and promote the slow outflow of blood. A 23-year-old first-time pregnant patient presented with severe preeclampsia, for which an emergency cesarean section was performed using regional anesthesia. During the postpartum period, the patient presented a single generalized seizure episode with secondary headache. The imaging study reported the presence of a lamellar subdural hematoma. This type of injury is a rare complication of lumbar puncture, where factors such as the use of very large needles, large dural orifice, multiple punctures, pregnancy, dehydration, use of anticoagulants, coagulopathies, cerebral vascular anomalies and atrophy cerebral.
complicaciones
Meningitis Criptocócica. Diferentes Contextos Clínicos y Complicaciones. Serie de 7 Casos. Cryptococal Meningitis. Different Clinical Context And Complications. Seven Cases.
Introduction. Cryptococcal meningitis (CM) is a serious infection of the Central Nervous System. The diagnosis and treatment of these patients is often complex, due to the severity of the clinical manifestations and their complications. The aim of this study is to describe the different clinical contexts, the neuroradiological characteristics and the complications of patients with CM.
Patients. We performed a retrospective review of clinical and radiological factors of 7 patient’s diagnosis and treated with CM during the period October 2016 and September 2017, at the Eugenio Espejo Hospital.
Results. Male sex was predominant (6/7), with an average age of 31.6 years (Range 19-44). The average time for the diagnosis was 8.1 weeks. Immunosuppression causes were evidenced in 5 patients, two HIV positive, one case with Acute Lymphoblastic Leukemia, CD4 idiopathic lymphopenia and Primary Intestinal Linfagectasia respectively. Three patients developed complications as disseminated cryptococcosis, visual acuity and hearing loss, mortality rate reach 26.8% of patients. Hypoglycorrhachia was a relevant feature with average 12.7mmg / dl. In MRI, the most common lesion was dilatation of Virchow Robins spaces (5/7), followed by ischemic lesions.
Conclusions. CM is characterized for high morbidity and mortality, initial symptoms may be nonspecific and delays the diagnosis as well as initiation of antifungal agents. Several predisposing immunosuppressive conditions can be found and sometimes a diagnostic challenge.
